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APPLICATION FOR SANITATION PERMIT Permit (Complete in Duplicate) Date Issued'__Q //_I/ Application is hereby made to the San Joaquin Local Health District for a permit to construct and install the work herein described. This application is made in compliance with County Ordinance No. 5449.E I JOB ADDRESS AND LOCATION ,S^, 1 _P�------�"--��------------------------------------------------------------------------------------------ Owner's Name----------------------------- r;--s---------A---------1--A0ee�_Rs0--n-------------------------------- Phone-------`'�__-7�_� ------ Address------------•------------------------------------------------------A - Phone----------------------------------- Contractor's Name--------------------------------------------- Installation will serve. Residence' Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ Number of living units: -------- Number of bedrooms __l___ Number of baths J___ Lot size ________SSX I� ----------------------------- Water Supply: Public system ❑ Community system ❑ Private JK Depth to Water Table ________ ft. Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam (] Clay ❑ Adobe)6 Hardpan ❑ Previous Application Made: Yes ❑ No 4 New Construction: Yes No ❑ TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tank or cesspool permitted if public sewer is available within 200 feet.) I Se Tan Di s e from nearest well________________Distance from foundation--------------------Material_____---------__--___________________--________- o. of comp meets--------------------------Size--------------------------------Liquid depth--------------------- ----Capacity------------------- Diswl Field: Distance from nearest well ___5-0____Distance from foundation------1_0--------Distance to nearest lot line_-_____- �__ Number of lines______________`)-----------------Length of each line-----------5Q't---------Width of french___-_______Z-1-1t ____________ Type of filter material___Tats,�^�,.�-----Depth of filter material------16�I---------Total length----------------NO ------------ Seepage Pit: Distance to nearest well----------------------Distance from foundation-------------._.___.Distance to nearest lot line_________________ � ❑ Number of pits----------------------Lining material-----------------------Size: Diameter-----------------------Dept h----------------------____------- Cesspool: Distance from nearest well-----------------Distance from foundation--------------------Lining material_ _____________-_____--_________- ❑ Size: Diameter--------------------------------------Depth----------------------------------------------------Liquid Capacity-------------------------gals. Privy: Distance from nearest well-------------------------------------------------Distance from nearest building---______________-__--___________________- ❑ Distance to nearest lot line v Remodeling and/or repairing (describe):-------------------------------------------------------------------------------------------------------------------------------------------------------- --------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------- I hereby certify that I have prepared this application and that the work will be done in accordance with San Joaquin County ordinance?1afe ws, and rulesandr ` talations of the San Joaquin Local Health District. (Signed)--- - -___ /_!- -------------- ---- ----------------(Owner and/or Contractor) By --•----------------------------------------------------------------------------------------------------------------(Title)--------------------------------------------------------------- (Plot planize of lot, location of system in relation to wells, buildings, etc., can be placed on reverse side). FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY----------------- _ ___ ___________--- DATE____________ - --- ------------------------------- REVIEWED BY ----------------- DATE-------------------------- BUILDING PERMIT ISSUED---------------------------- --------- ---------------- DATE Alter ions anal/1or recommend ions______ ___ _ _ -�- { ------- -- --- t---y ----- ------ � ? - sr -��.----------- ---- - - - ---4W_ ------------------- ---------------- ------------------ --------------------------------------------------------------- FINAL INSPECTION BY:--------- '--------------------------- Date----1.11-4-(�5_ -�---------------------------------------------- SAN JOAQUIN LOCAL HEALTH DISTRICT 130 South American Street 300 West Oak Street 132 Sycamore Street 814 North "C" Street Stockton, California Lodi, California Manteca, California Tracy, California ES-9-2M 8-51 Revised W-2100 �...